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Radiographer reporting - a happy ending?

A packed and globally diverse audience attended a reporting radiographers’ study session at Guy’s Hospital, London earlier this year to hear speakers presenting papers on a wide variety of topics, particularly focused on the development and implementation of radiographer chest reporting.

A lively panel discussion also explored why there is still resistance to radiographer reporting, given the mounting research and evidence available.

The evening was chaired by Nick Woznitza, a clinical academic reporting radiographer, who told delegates: “It’s really important to use the expertise you already have in your departments.

"However, it’s also important to focus on education and training, as advanced education and qualification requirements are not optional any more to develop advanced practice to where we want it to be.”

Matthew Stork, managing director of InHealth, co-organiser of the event, kicked the evening off by emphasising the need to support reporting radiographers and the radiography profession in general. His statement was echoed and endorsed time and time again throughout the evening by both the invited speakers and the delegates.

Head of radiographer reporting at InHealth, Fodi Kyriakos, welcomed delegates, saying: “There is growing evidence of the significant, positive impact that reporting radiographers are having, especially in terms of capacity, improving diagnosis and delivering positive benefits to the patient and the organisation.

“Radiographer reporting is as topical now as it was 20 years ago and it is critical that it becomes unanimously accepted across radiology. The challenges cannot be underestimated. The government wants more from the profession with less resources. Radiographer reporting is a vital and an inevitable development."

SCoR president, Steve Herring, a Kent-based reporting radiographer himself, also welcomed guests, adding: “We have proved time and time again that radiographers can make a difference.

"I am always amazed at the advancing practice of the profession and since becoming president, it has been a privilege to see it first-hand.”

He continued by saying that, although there has been resistance from some quarters including radiologists, that the profession is making small but significant steps, and that these can make the biggest differences, especially to patients.

By 2021, the SCoR is looking for advanced practitioners to have a master’s degree and consultants to be working towards a PhD.

“Assistant practitioners are our support service which allows us to develop our clinical practice - use them!” Sue said.

Working at the top of your license is crucial: “If you have a skill, you have to use it and work at the highest level you can,” she said.

“Everyone should be promoting practice and this is done using research. Everybody should be involved in research.”

“The survey has shown that radiographers’ scope of practice is very broad and expanding; we have experts working across a wide range of services,” Sue said.

Key messages:

Shout about what you do

Find best practice and implement it

Look for the new workforce

Make much greater use of all your skills

Are you working at the top of your game?

Accept the challenges of workforce size

Keep that patient in mind

It’s all about the patients

How to implement radiographer reporting: A toolkit for departments
Alice Turner, advisor for diagnostic imaging, faculty of health, Keele University, explained how the toolkit had been developed to assist departments in the analysis of the demand and capacity within radiology and, ultimately, the efficacy of implementing radiographer chest reporting.

"The service is stretched and patients are having to wait too long for their reports, with the situation as it is currently," she said.

"Radiographers are fully able to produce reports to the same standard as radiologists. The evidence is already there," Alice told delegates. "However, chest reporting is not particularly widespread in the UK and not happening at all in some areas.

“There is on average a 15% vacancy rate for consultant radiologists in the face of increasing demand, and outsourcing is definitely not the answer,” she said. “Radiographer reporting improves outcomes for patients, increases capacity and quality, contributes to education and improves recruitment and retention.”

Alice walked the audience through the toolkit which advises users how to understand demand, turnround times and backlog, and covers job plans, reporting patterns, gap analysis and workforce capacity, as well as quality assurance, audits and governance.

“Developing an evidence-based business case is crucial,” said Alice. “Make sure the financial aspects are covered. How much it’s going to cost and if those costs can be mitigated. Don’t underestimate how much time and commitment training will require, but at the same time ensure you are making the most of the expertise you already have.”

“The evidence is all there, so what’s stopping you?” she asked.

Is radiographer CXR reporting cost effective?
Professor Paul McCrone, professor of health economics, Kings College, London gave an illuminating presentation about research undertaken by a master’s student.

The questions asked were: Can we increase the overall level of provision with reporting radiographers? Does it save money? Is it cost-effective? Are patient outcomes improved, making it cost-effective and money saving in the long-term?”

The results showed that overall, radiographer CXR reporting for lung cancer diagnosis was a cost-effective alternative in the long-term, taking into account treatment costs and quality of life, when measured using the NICE QALY (quality-adjusted life year) threshold figures.

A happy ending
Professor Nigel Thomas, a consultant radiologist from Manchester, said, “The argument has already been made; if we didn’t have reporting radiographers, the NHS would fail.”

An ardent supporter of reporting radiographers, he gave the audience a potted history of the relationship between radiology and radiography from the early days of the 20th century and the evolution of the
extended role. He also described the development of his own relationship with radiographers, which began in the 1990s, when he was invited to run a course on reporting at Salford, and a visionary superintendent had sent some of her radiographers along.

Concerning the present day, he said: “It concerns me that reported images are not being reported, they are auto-reported. The 'gold standard' is not the gold standard.”

He gave delegates some advice about making a solid and indisputable case for reporting: “Audit and governance are really important. Audit is like a cycle helmet, it doesn’t stop you having an accident but it can save your life and it may make you a better cyclist.”

The future as he sees it: “An increasing number of experienced and knowledgeable reporting radiographers will become the mainstay of plain film reporting in the NHS. They will have a major role to play in
the reporting of other modalities and, through the use of practical skills, will contribute to patient management.”

“We should be proud of what has been achieved, but not complacent. We should also recognise that even though some still oppose the process, we have come a long way and we have not yet reached the end.”